Do I Need a Bone Density Test?Your questions answered

The current Canadian guidelines suggest that all men and women should have a bone density test if they are over the age 65. Younger people may have a bone density test if they have certain conditions known to weaken bones or lower the body’s ability to absorb calcium. Those with a low risk of fracture may repeat a bone density test in five to 10 years. People at higher risk may be advised to test more often. Protecting bone health begins long before you reach the age where bones are at higher risk of breaking. As you grow older, you may need to actively prevent fractures. While bone density testing and supplements play a role, advice on when to use them is changing.

Older adults are more likely to develop osteoporosis, a condition that makes bones thin and weak. In severe cases, bones can fracture with relatively little trauma, like falling from standing height or rolling over in bed. Sometimes a bone can break without the person even being aware of the damage. The most common sites for fracture are hip, wrist, shoulder and spine.

Why avoid fracture?

In an older adult, breaking a bone can have serious consequences. A fracture might mean a hospital stay, a surgery to fix the bone, a period of rehabilitation, chronic pain, less mobility and loss of independence. It puts you at higher risk of complications like blood clots, infections, and further falls. Returning home may or may not be possible. This will depend on many factors, such as whether you can care for yourself, do household chores like cooking, or have problems with stairs.

As you get older, reducing your risk of fracture is just as important as reducing that of heart attack or stroke. Many people become more aware of this risk as they get older. However, protecting bones can start as early as childhood and adolescence, by establishing good habits of eating well and exercising. Don’t be surprised if your doctor says that a bone density test is not required, even if you’ve had bone density tests every couple of years in the past.

Why test bone strength?

How can you know whether osteoporosis affects you? While a bone density test can help, the guidelines have changed. New understanding of bone health suggests that risk of fracture involves more than just bone density. Measuring bone density is still important, but testing is not needed as often as was once believed.

Osteoporosis risk

Your risk of breaking a bone depends on several factors. These include:

age

gender (women are at highest risk)

race (Asian and Caucasian are at highest risk)

height and weight

smoking

taking medications that deplete bone

alcohol intake

bone density

medical conditions that hinder calcium being absorbed by the body.

Startling statistics from Osteoporosis Canada

One in three women and one in five men will suffer a bone fracture due to osteoporosis in their lifetime.

Fractures from osteoporosis are more common than heart attacks, strokes and breast cancer combined.

Peak bone mass is achieved at an early age 16 to 20 in girls, and 20 to 25 in young men.

Many who suffer a hip fracture will die within the following year – 28 per cent of women and 37 per cent of men.

Risk calculators that consider these factors can help determine your risk of breaking a bone in the next ten years. Your doctor can do this calculation with or without a bone density test. This calculation can also help determine whether you might benefit from medication that protects bone density. Next time you and your dictor discuss bone health, instead of asking ‘Do I need a bone density test?”, try asking “What is my fracture risk?”
Bone-protecting medications

Until recently, bone-protecting medications known as bisphosphonates were prescribed to otherwise healthy women in their 50s and 60s when reduced bone density was found.

In reality, many of these women were at a lower risk of suffering from a fracture due to fragile bones.

We now know that these medications are most effective in older people more likely to have a fracture. New evidence also suggests that they work best over a short period of time, such as five to ten years. Using them longer may not benefit the bone, and may even carry a small risk of harm.

When used appropriately, bisphosphonates have been shown to reduce the risk of fractures due to osteoporosis by 30 to 40 per cent. For instance, if your fracture risk is 20 per cent, taking a bisphosphonate for three years reduces that risk by 30 to 40 per cent. This brings your risk down to 12 to 14 per cent.

Some problems associated with these medications have received media attention. They include osteonecrosis of the jaw (bone death caused by poor blood supply), ‘atypical’ fractures of the femur (thigh bone), cancer of the esophagus (the tube from the throat to the stomach), and atrial fibrillation (where the heart does not beat in proper rhythm). However, the number of these negative events remains rare.

Today, people who have taken these medications for years may be advised to stop them. Other types of medications can also be used to protect bones. Hormone replacement therapy is one possibility. The decision to use medication is a very individual one that you and your doctor must weigh together.

Protecting your bones

The good news is that whether you are 34 or 84, there are plenty of ways to protect your bones without medication.

Maintain or improve your muscle strength as you get older. Do activities to strengthen your muscles a couple of times a week to reduce your chance of falling.

Maintain or improve your balance. Practice standing on one leg for 15 seconds. Hold onto the back of a chair until you can do it without support. Next, do it with your eyes closed. If you are not limited by a medical condition, put on your pants, socks, and shoes standing up.

Do weight-bearing exercise like walking.

Eat a balanced diet.

Do not smoke or drink too much alcohol - no more than one drink per day for women, and two for men.

Bones need calcium, so be sure that you are getting enough in your diet. Do not overdo it though, as there is evidence that too much calcium can increase the risk of heart disease. The calcium goal from all sources, including supplements, is 1200 mg/day for adults over age 50. For a chart on calcium content of foods, see the Osteoporosis Canada website.

Vitamin D reduces the risk of falling in seniors. This vitamin is present in small amounts in our diet, mostly from fortified sources like cow’s milk. It is made in our bodies by exposure to sunlight. In Canada, our sunlight is only intense enough to make vitamin D in late spring and summer. All Canadians should take a vitamin D supplement. For adults, the current recommendation is 1000 IU of vitamin D each day.

Clear your floors of clutter, including rugs with edges that could trip you.

Turn on the lights and put your glasses on if you have to get up in the night.

Make certain that your glasses and hearing aids are working properly

The medical understanding of osteoporosis, bone density testing, and bisphosphonate treatment is changing rapidly. The advice your doctor gave two years ago about osteoporosis testing and treatment may differ today. Protecting your bones with a healthy lifestyle of exercise, healthy eating, and avoiding smoking and excessive alcohol intake is advice that never changes.